Systems and methods for implementing personalized health and wellness programs

ABSTRACT

A system configured to receive health data pertaining to a user; select a user health profile from a plurality of user health profiles based on the collected health data, each of the plurality of user health profiles being associated with a health and wellness program and a set of interventions; receive user activity data and updated health data pertaining to, or during the user&#39;s participation in the associated health and wellness program from health devices; select a new set of interventions based on the user activity data; and select a new user health profile from the plurality of user health profiles based on at least one of the user activity data and the updated health data.

RELATED APPLICATION INFORMATION

This application claims priority as continuation in part to U.S. patent application Ser. No. 14/034,505, entitled “Systems and Methods for Developing and Implementing Personalized Health and Wellness Programs,” filed Sep. 23, 2013; Ser. No. 14/034,508, entitled “Interactive Graphical User Interfaces for Implementing Personalized Health and Wellness Programs,” filed Sep. 23, 2013; and Ser. No. 14/034,466, entitled “Systems and Methods for Dynamic Adjustments for Personalized Health and Wellness Programs,” filed Sep. 23, 2013, each of which claims priority to U.S. Provisional Patent Application Ser. Nos. 61/722,774, entitled “Systems and Methods for Developing Personalized Health and Wellness Programs Using Genomic and Physiological Information,” filed Nov. 5, 2012, and 61/704,415, entitled “Interactive Health and Wellness Dashboard and Methods for Generation Thereof,” filed Sep. 21, 2012. All of the above are incorporated by reference in their entirety as if set forth in full.

BACKGROUND 1. Technical Field

The embodiments described herein are related to interactive mobile health devices and applications, and more particularly to an interactive dashboard graphical user interface which collects health information for a user, displays a personalized health and wellness program, tracks the user's activity using the mobile health devices and applications and provides notifications, rewards and incentives to the user for participation in the health and wellness program.

2. Related Art

A person's overall health and wellness is the result of a number of different factors. Genetic profiles, medical history, fitness activity and nutrition all affect a person's overall health and wellness. The interrelationships between all of these factors are still not fully understood and are the subject of continuing research. However, even for factors which are individually known to be the cause of disease or promote health and wellness, there is no mechanism for a person or even a healthcare provider to attempt to understand these factors, how they relate to each other and how they may be utilized in optimizing a person's overall health and wellness.

Cardiac disease is the leading cause of death, and has been since 1918. Someone has a heart attack or stroke every 10 seconds, amounting to 2,400,000 deaths in the United States each year. 1 in 3 adults in the U.S. will die from cardiovascular disease, and not surprisingly, 1 in 3 adults in the U.S. are obese. 1 in 3 people also have undiagnosed cardiovascular disease, and cancer and heart disease combine for over half of the deaths in the U.S. each year. The traditional methods of treating cardiovascular disease are not driving down mortality, and studies are beginning to show an “obesity paradox” based on the lack of correlation between adiposity and cardiovascular disease. FIG. 1 is a bar graph illustrating a comparison between body mass index (BMI) and central obesity (via waist-to-hip ratio) in assessing mortality of subjects with coronary artery disease. As shown in FIG. 1 , the highest mortality rates are found in individuals with a waist-to-hip ratio of greater than 1, indicating a large amount of visceral fat surrounding the abdominal organs. The mortality rate is even higher amongst the individuals with a waist-to-hip ratio greater than 1 who have an overall low BMI of 18.5-21.9, indicating that an individual with a low BMI and a concentration of fat only around the waist are the most at-risk individuals.

FIG. 2 further illustrates this statistic via the body-shape illustrations of the individuals represented in the bar graph of FIG. 1 . As stated below the illustrations, the increased risk of mortality of Person 2 (the individual with a lower BMI but a high waist-to-hip ratio) is statistically significant in comparison with the other individuals, including Person 5, who would be classified as morbidly obese. Additional recent studies have also noted the unusual lack of correlation between BMI and morbidity, once thought to be the primary measurement indicative of health, likelihood of disease and overall morbidity.

Existing methods of promoting weight loss, better diet and regular exercise fail to account for the peculiarities of the obesity paradox, and are therefore failing to address the root cause of morbidity for a large population of individuals which are at risk of cardiovascular disease.

SUMMARY

The embodiments described herein relate to systems and methods for managing care for a large population of individuals.

Accordion got one aspect, a system for implementing personalized health and wellness programs, comprises: one or more storage devices configured to store user health data and user activity data; memory configured to store instructions; one or more processor coupled with the one or more storage devices and memory, wherein the instructions are configured to cause the processor to: receive health data pertaining to a user; select a user health profile from a plurality of user health profiles based on the collected health data, each of the plurality of user health profile being associated with a health and wellness program and a set of interventions; receive user activity data and updated health data pertaining to, or during the user's participation in the associated health and wellness program from one or more health devices; select a new set of interventions based on the user activity data; and select a new user health profile from the plurality of user health profiles based on at least one of the user activity data and the updated health data.

According to another aspect, a method of implementing personalized health and wellness programs, comprises the steps of: receiving health data pertaining to a user; selecting a user health profile from a plurality of user health profiles based on the collected health data, each of the plurality of user health profile being associated with a health and wellness program and a set of interventions; receiving user activity data and updated health data pertaining to, or during the user's participation in the associated health and wellness program from one or more health devices; selecting a new set of interventions based on the user activity data; and selecting a new user health profile from the plurality of user health profiles based on at least one of the user activity data and the updated health data.

According to still another aspect, A method of implementing personalized health and wellness programs, comprises the steps of: receiving health data pertaining to a plurality of users; sorting each of the plurality of users into groups by selecting a user health profile from a plurality of user health profiles based on the collected health data, each of the plurality of user health profile being associated with a health and wellness program and a set of interventions; receiving user activity data and updated health data pertaining to, or during each of the plurality of the user's participation in the associated health and wellness program from one or more health devices associated with each of the plurality of users; for at least some of the plurality of users, selecting a new set of interventions based on the associated user activity data; and for some of the plurality of users, selecting a new user health profile from the plurality of user health profiles based on at least one of the user activity data and the updated health data.

According to still another aspect, A system for implementing personalized health and wellness programs, comprises: one or more storage devices configured to store user health data and user activity data; memory configured to store instructions; one or more processor coupled with the one or more storage devices and memory, wherein the instructions are configured to cause the processor to: receive health data pertaining to a plurality of users; sort each of the plurality of users into groups by selecting a user health profile from a plurality of user health profiles based on the collected health data, each of the plurality of user health profile being associated with a health and wellness program and a set of interventions; receive user activity data and updated health data pertaining to, or during each of the plurality of the user's participation in the associated health and wellness program from one or more health devices associated with each of the plurality of users; for at least some of the plurality of users, select a new set of interventions based on the associated user activity data; and for some of the plurality of users, select a new user health profile from the plurality of user health profiles based on at least one of the user activity data and the updated health data.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention and, together with the description, serve to explain the objects, advantages, and principles of the invention. In the drawings:

FIG. 1 is a bar graph illustrating a correlation between body mass index, central obesity and morbidity;

FIG. 2 is an illustration of different body types based on body mass index and central obesity as they relate to morbidity;

FIG. 3 is a diagram illustrating a system and method of collecting and analyzing user-specific data to develop comprehensive, personalized health and wellness programs, according to one embodiment of the invention;

FIG. 4 is a block diagram illustrating the relationship between sources of user-specific data and how they are utilizes to develop the personalized health and wellness programs, according to one embodiment, the results of which are reflected in the health and wellness dashboard;

FIG. 5 is a flow diagram illustrating the relationship of personalized data with software to derive plans that drive outcomes, according to one embodiment of the invention;

FIG. 6 illustrates a method of improving a user's health and wellness, according to one embodiment of the invention;

FIG. 7 is an illustration of a time-based implementation of a method of collecting and analyzing user-specific data to develop comprehensive, personalized health and wellness programs, according to one embodiment of the invention;

FIGS. 8A and 8B illustrate a chart utilized for measuring beats per minute while assessing the user's maximum heart rate;

FIG. 9 is an illustration of a graphical user interface (GUI) health and wellness dashboard which displays user profile and health and wellness program data to the user, according to one embodiment of the invention;

FIG. 10 is an illustration of a further embodiment of the health and wellness dashboard displaying a plurality of user-profile data and health and wellness program data to the user, according to one embodiment of the invention;

FIG. 11 is an illustration of a computing device displaying the dashboard GUI, according to one embodiment of the invention;

FIG. 12 is a further illustration of a dashboard GUI, according to one embodiment of the invention;

FIG. 13 is a further illustration of a health dashboard interface, according to one embodiment of the invention;

FIG. 14 is an illustration of a fitness dashboard interface, according to one embodiment of the invention;

FIG. 15 is an illustration of a nutrition dashboard interface, according to one embodiment of the invention;

FIG. 16 is an illustration of an alerts interface, according to one embodiment of the invention;

FIGS. 17A and 17B are illustrations of a notification displayed on a portable electronic device, according to one embodiment of the invention;

FIG. 18 is an illustration of a GUI of a group health and wellness dashboard illustrating a plurality of information aggregated for a group of people; according to one embodiment of the invention;

FIG. 19 is an illustration of a GUI of a clinical dashboard for use by a medical or healthcare professional in evaluating the health and wellness of one or more users, according to one embodiment of the invention;

FIG. 20 is another illustration of the GUI of the clinical dashboard with a plurality of notifications for the one or more users, according to one embodiment of the invention;

FIG. 21 is another illustration of the GUI of the clinical dashboard with additional nutrition information displayed for one or more users, according to one embodiment of the invention;

FIG. 22 is an illustration of a GUI of an interactive messaging service integrated into the health and wellness dashboard for communication between the user and the medical or healthcare professional;

FIG. 23 is another illustration of the GUI of the clinical dashboard with additional health information displayed for one or more users, according to one embodiment of the invention;

FIG. 24 is an illustration of a points activity interface, according to one embodiment of the invention;

FIG. 25 is a table illustrating a points reward system, according to one embodiment of the invention;

FIG. 26 is another table illustrating an outcomes-based points reward system, according to one embodiment of the invention;

FIG. 27 is a further table illustrating an incentives-based points reward system, according to one embodiment of the invention;

FIG. 28 is an yet further table illustrating additional points rewards, according to one embodiment of the invention;

FIG. 29 is a table illustrating physiological changes in a set of patients over a period of time after using the systems and methods described herein, according to one embodiment of the invention;

FIG. 30 illustrates the overall statistical change in numerous health metrics, including BMI, body fat, trunk fat, RMR and VO2;

FIG. 31 illustrates the change in BMI;

FIG. 32 illustrates the change in body fat;

FIG. 33 illustrates the change in trunk fat;

FIG. 34 illustrates the change in resting metabolic rate (RMR);

FIG. 35 illustrates the change in VO2, according to one embodiment of the invention;

FIG. 36 is a block diagram that illustrates an embodiment of a computer/server system upon which an embodiment of the inventive methodology may be implemented;

FIG. 37 is a diagram illustrating the sortation of a large population into specific patient groups based on demographic, clinical and behavioral data in accordance with one embodiment; and

FIG. 38 is a graph illustrating user feedback that can be used to update a set of interventions associated with a user profile that in turn is associated with the patient groups of FIG. 37 in accordance with one embodiment.

DETAILED DESCRIPTION

After reading this description it will become apparent to one skilled in the art how to implement the invention in various alternative embodiments and alternative applications. However, all the various embodiments of the present invention will not be described herein. It is understood that the embodiments presented here are presented by way of an example only, and not limitation. As such, this detailed description of various alternative embodiments should not be construed to limit the scope or breadth of the present invention as set forth below.

The embodiments described herein relate to collecting and analyzing user-specific medical, genetic, fitness, environmental and nutritional data to develop comprehensive, personalized health and wellness programs for improving key health factors which have a high correlation to common morbidities. The user-specific data may be collected from a variety of sources, including traditional medicine, genetic testing, lab testing, nutrition information, fitness, metabolic testing, mobile health devices worn by the user and applications through which the user manually inputs information. The user-specific data is then collected and analyzed together based on knowledge of the interrelationships between medical, genetic, fitness, environmental and nutrition data to develop a comprehensive user profile. The user profile is then used to develop personalized health and wellness programs that are targeted to improving key health factors such as oxygen consumption (VO₂), metabolism, visceral fat, body fat and posture, amongst others, by implementing changes in the user's fitness, nutrition, health care, environment and other behavioral components. The user is provided with a customized, interactive graphical user interface dashboard and one or more mobile health devices and applications to track and monitor their current health and wellness data and motivate the user to achieve their personalized goals. The dashboard provides notifications and alerts, points and rewards and analytics of user and group data which can be viewed by the user, a healthcare professional or healthcare plan administrator to monitor and adjust the programs to obtain optimal results.

The systems and methods described herein utilize mobile health technology and analytics to develop comprehensive health and wellness programs customized for each user based on understandings of the interrelationship between medical, genetic, fitness, environmental and nutrition data. By leveraging the same mobile health technology which collects the initial data to continually monitor multiple aspects of the user's health, the user's progress in implementing the health and wellness programs can be easily monitored and adjusted based on their progress to optimize their goals.

The health and wellness programs described herein are designed to create statistically significant changes in key health factors—such as oxygen consumption, resting metabolic rate and visceral fat—which have high correlations with reductions in leading morbidities and lead to greater improvements in the user's overall health and wellness.

I. System Overview

FIG. 3 illustrates one embodiment of a system 100 of collecting and analyzing user-specific data to develop comprehensive personalized health and wellness programs. In this embodiment, data on a user is collected from a plurality of sources 102, such as a mobile health device 102A, a mobile application on a portable electronic device 102B or through manual user entry 102C via a computing device. The mobile health devices and mobile applications may be configured to collect information on the user as the user wears or uses the device. In one embodiment, these devices may communicate with one or more source servers 104, such as device or application servers that receive data collected and then communicate with a dashboard server 106 of a front-end cloud server to collect the data for analysis. In addition to the devices, additional user data may be collected at the dashboard database in the form of genomic data 102D from a genomic report or lab results 102E from lab tests that the user has undergone. Additional data may be entered manually by the user, the user's physician, fitness trainer or other health and wellness professional by a computing device, as illustrated in 102C. The dashboard server and database 106 will collect and store all of the medical, genetic, fitness, environmental and nutrition information about the user that will then be analyzed to generate a user profile.

The mobile health devices 102A may be configured to continually collect and report data to the dashboard database in real-time or at periodic increments so the user profile can be continually updated to provide the most relevant information about the user's health and wellness. The mobile health devices may be connected to a network and configured to wirelessly transmit data to the dashboard server and database 106 or through a device-specific or application-specific server such as the source server 104. Some devices may require user input, such as a nutrition application running on a portable electronic device in which the user inputs dietary and nutrition information. The user may be responsible for submitting the data manually as it is entered or at periodic time periods after a certain amount of data is collected. In some embodiments, the nutrition data may be obtained from mobile health devices or at least more accurately tracked by software or applications running on the portable electronic device 102B (such as a tablet or smartphone). Similarly, some user fitness data may be generated or reported by a user.

Once the user data is collected at the dashboard database, the dashboard server 106 will use the data in order to analyze the data and generate a user profile. In this embodiment, the data in the dashboard server and database 106 is protected by a secure firewall 108, and additional firewalls may be placed throughout the system to protect data being transmitted across the system. The dashboard server 106 then analyzes the data using customized algorithms which leverage understandings of the relationships between the medical, genetic, fitness, environmental and nutrition data in order to generate a user profile.

The user profile is then used to generate at least one health and wellness program at the dashboard server 106 which contains recommendations for the user specific to their medical health, fitness, nutrition and environment. The recommendations may relate to recommended user activity such as exercise, behavioral changes related to their environment (such as sleep), or nutrition recommendations related to their diet. In addition, the recommendations may relate to achieving desired physiological measurements of visceral fat, resting metabolic rate, body fat, posture, cholesterol, blood pressure, body mass, etc.

The user profile and health and wellness programs may be displayed to a user on a graphical user interface (GUI) in the form of a dashboard 112 of information which provides an interactive, visual summary of the user's health and wellness as compiled and analyzed by the dashboard server 106. Once the dashboard is generated, it may be customized and transmitted to one or more destination devices for display to an interested party, including the user dashboard 112A (patient), a healthcare team dashboard 112B for healthcare professionals responsible for the user's health, or a corporate wellness dashboard 112C for an administrator set up to monitor the user's progress toward specific health goals. The users, healthcare professionals and administrators may interact with the dashboard through a user interface server 110 which will communicate with the dashboard server and database 106.

The mobile health devices 102A and other applications 102B will continue to be utilized to report new user data once the user has begun to implement the health and wellness programs, and this new data can then be used by the dashboard server 106 to compare with the original user data to determine if the user is implementing the health and wellness programs and achieving improved health and wellness through the implementation of the programs. The new and original data may be displayed on the dashboard 112 in graphical or other visual forms to help the user or a health professional easily view the user's progress toward one or more goals related to the health and wellness programs. By obtaining continuous feedback from the user, the health and wellness programs may be continually modified.

FIG. 4 is a graphical illustration of the relationships between sources of user-specific data and how they are utilizes to develop the personalized health and wellness programs. The metabolic health assessment 402, genetic and traditional lab testing 404, personalized nutrition and fitness plans 406 and mobile health devices 408 all operate through optimization of integrated software 410 at the system level to improve the overall health and wellness of the user. Additional details of these relationships will be provided further herein. FIG. 5 is a flow diagram illustrating the relationships of personalized data 502 with software 504 to derive plans 506 that drive outcomes 508. The software 504 obtains the personalized data 502 from the user through the user assessments, and then develops the personalized plans 506 for the user to implement. The plans 506 are then monitored and evaluated through the mobile health devices connected with the user and the dashboard interface, all of which drive positive outcomes 508 for the user in terms of reduced morbidity and improved health and wellness, improving the user's personalized data 502.

II. Program Steps

FIG. 6 illustrates one embodiment of a method of improving a user's health and wellness, according to one embodiment of the invention. In a first step 202, data on the user is collected, such as information on the user's medical, genetic, fitness and nutrition. Existing medical conditions, genetic predispositions, exercise abilities including body performance testing, diet, caloric intake, etc. may all be collected. In a next step 204, a user profile is developed which summarizes the health and wellness of the user based on the collected data. Grading, scores and other ratings are also determined with the user profile to provide an easy to understand metric that assesses the user's overall health and wellness and their risks for morbidities. The grades and other scores, along with specific identified risk factors, will be utilized to develop health and wellness programs in step 206. The health and wellness programs are customized to address the user's specific factors that are identified as causes of high risks of morbidity, such as visceral fat, excess body fat, low oxygen consumption, poor posture and low RMR. The program includes recommendations for specific exercise, nutrition, diet, activity, sleep and health care treatment. In step 208, once the user is provided with their program, the user is provided with one or more wireless health devices and applications to track their participation in the program. This includes tracking their general activity (steps, exertion, sleep), heart rates and recovery (such as during a workout), caloric intake and food type, weight, BMI, etc. The activity may be tracked and entered through separate devices configured for each measurement parameter or through a combined device integrated into a portable electronic device such as a smartphone or tablet. The portable electronic device may run applications which receive the data and transmit it to the dashboard server, and other wireless health devices may be configured to transmit the data through their own device servers to the dashboard server. The user is also provided with the interactive dashboard graphical user interface, where they can view and track their activity and progress and communicate with plan administrators, healthcare professionals and other users (step 210). In step 212 the user may be provided with points and rewards as an incentive for completing and progressing through various steps of the plan. In step 214, the user's progress may be evaluated at certain time points during the plan to assess their progress and physiological changes. The user's progress, whether good or bad, and the newly received information from the assessment and the wireless health devices, may be utilized to adjust the program in one or more aspects to help the user more effectively achieve their goals (step 216). For example, as the user begins an exercise program and increases their RMR and VO2 and decreases their heart rate recovery, their recommended caloric intake and food balance may be adjusted to account for their increase in calories burned, or their heart rate and heart rate recovery goals may be adjusted based on their recently collected data. These adjustments may be made in real-time as the data collected from the mobile health devices is received or as the user's health is re-assessed at regular intervals. The parameters of the health and wellness program may be individually adjusted, and the parameters may be adjusted to reduce or simplify the requirements of the program if the user's activity has dropped or the user's health is re-assessed to be lower than a previous assessment. The adjustments may then be displayed to the user on the dashboard graphical user interface or transmitted via a notification so the user can implement the changes in real-time

The timeline and specific steps of the system and method are set forth in further detail in FIG. 7 . In a first enrollment and kick-off step 702 scheduled for Month 1, initial assessments 704 and consultations 706 are performed on the user, including a biometric assessment, segmental body composition analysis, resting metabolism and cardiovascular fitness (VO2) test. This is followed by a medical examination with a clinician and the scheduling of lab tests. Genetic testing is also performed in this step in order to obtain data that may be relevant to the user's overall medical condition, health and fitness ability and nutritional predispositions. The enrollment step also includes a nutrition consultation 706 for an analysis of current diet and eating habits and the creation of a personal food plan designed to achieve health goals. The user will then be provided with fitness assessment 708 personalized to their current level of fitness in order to develop specific recommendations for exercise and activity that will help them improve as quickly as possible. The fitness assessment 708 includes establishing a personalized heart rate zone and a detailed explanation of the fitness and exercise program of interval training. Finally, the user will be issued one or more mobile health devices and related software (such as a smartphone app) for tracking and monitoring their activities.

In Month 2, the user begins (at step 710) engaging with the system and learning healthy behaviors as they begin following the program instructions for exercise, nutrition and any medical interventions. This may include monitored exercise sessions 712 where the user is guided through the fitness interval training to maximize their heart rates and reduce their overall recovery time. During Month 2, the user may be reevaluated (step 714) with regard to their RMR and body composition to discuss their short term progress. A detailed genetic review 716 may also be completed as this stage to help the user understand the genetic components of their metabolism, response to exercise, propensity for vitamin deficiencies, eating behaviors and food reactions.

In Month 3 (step 724), a complete reassessment of the user is completed in order to adjust the user's training and exercise, caloric intake, etc. based on their progress. A complete biometric assessment 728, including segmental body composition analysis, resting metabolism and cardiovascular fitness (VO2) test is performed again in order to compare with previous results. A review of the nutrition plan may also be completed, and adjustments made based on the user's progress, improvements and compliance.

In Month 4-6, the user is provided with continued coaching and engagement (step 726) with the system in order to keep the user involved in the program and maintaining their improved health and fitness. This includes interactions with their user profile over the dashboard and user interfaces, points systems and rewards to provide continuous incentives, and additional assessments of the user to determine if the user is maintaining or continuing to make progress toward long term goals.

The steps may be achieved over a period of time designed to provide a gradual improvement in the user's health and wellness and build good behavior without overwhelming the user with information and tasks. In one embodiment, the primary assessment, engagement and reassessments steps may be completed over a period of approximately three months, with the continued coaching and engagement steps occurring over another two months to ensure continued compliance with the program. However, the program could ideally continue indefinitely in order to motivate the user to continue with the program and attain an ideal health profile.

III. Collecting User Data

In one embodiment, the data sources which collect and transmit data on the user may include a scale for measuring weight and body composition, a pedometer or other exercise monitor which measures steps and calories burned, a heart rate monitor, a continuous glucose monitor, a blood pressure monitor and a sleep monitor. These devices are only exemplary, and numerous other health, fitness, environment and nutrition monitoring devices may be implemented and used to generate user data. These devices may be added to a user's account so that the device can transmit data to the front-end cloud server, either wired or wirelessly through a connection to a network or with a user's computer or portable electronic device running software which receives data from the third party data sources and transmits it to the front-end cloud server. Many wireless health devices have open application programming interfaces (APIs) which allow them to be easily integrated with a system running on the front-end cloud server that will compile, analyze and display the data.

The type of data that may be collected about a user relates to the user's medical, genetic, fitness, environment and nutrition. The medical data may include general information on disease or known health problems, but may also include specific physiological or biochemical measurements, examples of which include heart rate, resting metabolic rate (RMR), VO₂, weight, body fat, visceral fat, muscle mass, body water, body mass index (BMI), bone mass and blood glucose. Genetic data may include core genomic information and more targeted genomic information that specifically relates to known genetic correlations with disease, nutrition, fitness and behavior. Fitness data may relate to exercise routines, types of workouts, length of time spent on exercise, calories burned, heart rates achieved, etc., while environmental data may relate generally to a user's lifestyle choices, such as sleep, smoking habits, commute times to works and hobbies and sports. Nutrition data may include information on the types of foods eaten, the calories consumed, the number of meals and snacks, beverages and alcoholic consumption, etc.

As illustrated in FIG. 8A and FIG. 8B, assessing the user's VO2 and heart rate recovery time is another data point to be collected in order to assess the user's overall health and fitness. The chart in FIG. 8A shows a list of time intervals 802 in a first column with a corresponding workload (speed/incline) value 804 in the second column of an exercise machine such as a treadmill. As time progresses, the speed/incline increases, which has a corresponding effect on the user's VO2, as provided in the third column 806. During the assessment, the healthcare professional or evaluator will enter the user's heart rate in beats per minute (BPM) 808 at each time interval in order to gauge the user's overall fitness and ability in terms of a maximum heart rate. A recovery period 810 is also measured at the end of the workload application, for example for about two minutes—in order to determine the ability of the user's heart to recover from the applied work. The recovery period is another key factor in assessing the user's overall health and fitness, and this recovery period metric will be used throughout the system to determine if the user's cardiac health and fitness is improving.

FIG. 8B shows a similar chart, but with increased speed/incline values 804 and corresponding increased VO2 values 806. Multiple graduated increases in workload may be provided during a user assessment at various stages of the embodied methods in order to gradually increase the workload on the user and increase their overall VO2 and RMR levels. As is evident from a comparison of the VO2 levels 806 in FIG. 8A and the VO2 levels 806 in FIG. 8B, the goal is to gradually increase the user's fitness to the point that their measured heart rates 808 are the same even though the workload and VO2 has significantly increased.

IV. Aggregating and Analyzing Data

In one embodiment, data from employees, patients and consumers are acquired via health assessment questionnaires, six independent wirelessly enabled mobile health-tracking devices that measure resting metabolism, blood pressure, blood glucose, heart rate during exercise, steps per day, activity/movement levels via an accelerometer, weight and body composition via a scale, cardiorespiratory fitness levels as defined by VO₂ (oxygen consumption during submaximal exercise testing) and calorie consumption. Additional laboratory data and genetic information are aggregated and analyzed as described below.

Age, weight, body mass index, gender, HDL cholesterol, LDL cholesterol, triglyceride levels, adiponectin, lipoprotein (a) levels, and systemic inflammation as defined by high sensitivity CRP are collected and key co-morbidities including obesity, diabetes, diabetes control, hypertension, coronary artery disease, prostate cancer, breast cancer, colon cancer, lung cancer, smoking status are all ascertained at the beginning of the assessment process.

Key genetic information is strategically acquired and includes polymorphisms indicating susceptibility to breast cancer, lung cancer, colon cancer, prostate cancer, hypertension, stroke, atrial fibrillation, coronary artery disease, diabetes, and obesity. Key genetic susceptibilities to vitamin deficiencies, blood pressure and diabetes response to exercise, and key behaviors related to psychosocial factors including eating disinhibition and satiety are recorded in the existing database.

Once all of the user data has been collected, the data is analyzed in order to generate a user profile which not only summarizes the data collected about the user but also provides analytical results about the user's health and wellness. As previously described above, FIG. 4 illustrates the interrelationships between the data collected by several data sources and the use of this data in generating the components of the user profile. The data sources may include mobile health devices, metabolic health assessments, genetic and traditional laboratory testing and personalized nutrition and fitness plans, although this list is not limiting by any means. Data on the user's health and wellness is collected from all of these data sources and then considered separately or in conjunction with one another in order to provide personalized health and wellness programs with recommendations on an interactive dashboard graphical user interface. The data is optimized to the benefit of the user by factoring in data from all of these data sources when generating recommendations for the user to improve his or her health and wellness

Ranking and rating systems are developed based on knowledge of which factors and comorbidities and which levels of those factors lead to improved health and wellness, reduced mortality, and better quality of life.

In one embodiment, the system ranks the health of a patient based on six key performance metrics tied to reduced chronic disease and death. The grading system is applied after cross referencing the database of comorbidities, genetic testing, and standard laboratory testing noted above

The six key performance metrics include visceral fat, body fat in percentage, resting metabolism as defined by calories of intake per day and overall oxygen consumption at rest (ml/kg/min), cardiorespiratory fitness, biomechanical assessment (that includes a posture screen), and overall bone density.

A segmental body scan is done to determine the individual's body fat percentage expressed as a total body fat percentage and then broken down to each arm, each leg, and trunk. It also gives segmental body fat in pounds for each leg, arm, and trunk/visceral fat. Being able to determine the pounds of visceral fat is very unique and is used as an important health risk appraisal. The scan also tells body water, muscle mass and bone mass.

Resting metabolism is established based on the individual's ability to process oxygen at rest (V02). It also gives the exact caloric intake the user should have to reach their weight goal, be it to lose weight, maintain weight, or gain weight. Resting metabolism varies widely across populations.

A method to assess baseline and follow up cardiorespiratory fitness scores are performed and are based on the individual's ability to process oxygen while exercising.

A bio-mechanical screen can quickly determine any posture/core imbalances that an individual has that might lead to injury and or back and joint pain. The assessments consist of 5 kinetic check points: head, shoulder, hips, knees, and feet.

Resting metabolism, body composition analysis, and cardiorespiratory fitness provide critical user profile data that is leveraged to establish a personalized health, fitness, and nutrition plan. Re-assessments are done at four week intervals to track progress with nuanced changes being incorporate and conveyed to the user either in person or the graphical user interface of the software application.

Health Grading System

One embodiment of a grading system as applied to an individual who is 55 years of age and with one chronic disease risk factor would look like the following. Resting Metabolic Rate, (V02), Goals and Grades. Resting rate of 3.5 ml/kg/min, grade, B−. Resting rate below a 3.5 ml/kg/min, grade, C. Resting rate above 3.5-3.8 ml/k/min, grade, B. Resting rate above 3.8-4.4 ml/kg/min, grade B+. Resting rate 4.5 ml/kg/min and above an A. The above grading may change according to age, gender, and co-morbidities, and is automatically applied via an integrated software application.

When the goals are set there are several factors used to determine the goals in body comp, Resting V02 and Exercising V02. Age, gender and genetics can have impact on all these parameters. Not all individuals will be able to reach an A grade in each category. It is the goal to ensure that the individuals have no C's as a grade once they have completed the program.

Metabolism/VO2 decreases as we age unless we take actions to counter it. The generic values of 3.5 ml/kg/min for resting metabolism and 35/ml/kg/min are considered typical of a young healthy male. Higher VO2 at rest and when exercising is linked to greater health and longevity, therefore we set the values above the “norms” for most individuals. This allows for a decrease with age but still does not allow the person to dip below the generic population values, providing a safety net of sorts.

In one embodiment, a goal is set of VO2 exercising to be 12 times that of their resting VO2 for most individuals. That would result in a grade of B. If the individual has a VO2 between 10 and 12 times their resting they receive B−. If the VO2 is between 12-14 times their resting they receive a B+. A VO2 greater than 14 times their resting is an A. If the individual has VO2 less than 10 times their resting they receive a C. The above grading changes according to age, gender, and co-morbidities and is automatically applied via the integrated software application.

Body Fat Percentage is based on the individual's baseline athletic ability or history of athleticism. Being able to obtain very low body fat % levels is based greatly on genetics of the individual. If they do not fall into the “Athlete” definition a less aggressive goal is set. Age, gender and genetics are all factors in determining body fat % goal.

The main focus on body composition is to decrease visceral/trunk fat as higher levels of visceral/trunk fat are tied to inflammation, heart disease and cancer. The athletic individual would have a goal of visceral fat of 10 lb. or less. For the majority the goal is between 15 or 20 lb. depending on existing co-morbidities. Those with 1 risk factor have a goal visceral fat level of less than 15 pounds. The scientific community states a visceral fat of 50 lb. or more (Visceral Score of 10 or higher) is a significantly high risk for major health issues. A visceral fat of 20 or less pounds is realistic if their exercise and nutrition is appropriate. This keeps the individual well below the significant health risk level. A visceral fat level of 10 lb. or less would be a score of A− or A. A visceral fat level of 11 lb-20 lb would be a score of B+ or B. A visceral fat score above 21 lb-25 lb. would be a B−. Anything 26 lb. above would be C.

Bone Mass Grade is based off a scale that has been determined by scientific community as average or below average and it is determined by the weight in bone the person has in comparison to the persons overall weight. If the person has average bone mass as predetermined by a scale the person gets a B, if the individual has below average bone mass they receive a C, if the person is well above the average value the receive an A.

Posture/Core Screen—As stated above posture and lack of core strength can lead to muscle, joint and back pain which also leads to decreased activity, productivity and often pharmaceutical use in individuals. Individuals who are older, 68 or above, who have these issues have limited range of motion and lack of balance. They are more likely to fall and break a bone. If all 5 kinetic chain check points are satisfactory the individual receives a grade of an A. If the individual has one kinetic check point that is not satisfactory the individual receives a B−. If the individual has more than one kinetic check point that is not satisfactory then the individual receives a C.

RevUp Age Calculation

Another grading mechanism is the calculation of the user's “RevUP age,” which is a measurement of the user's actual age based on their VO2 max (mL/kg/min) measurements or heart rate recovery. An individual's VO2 is highly correlated with age, so this RevUp age score provides a numerical value that is easy for a user to understand and which clearly indicates the effect (positive or negative) on their age as a result of their VO2. The user's RevUP age is a metric of their overall health in years as compared with their actual chronological age, where their RevUp age may be less than their actual age if they have a good VO2 level, but more than their actual age if they have a poor VO2 level, as indicated by the exemplary guidelines in Table 1 and Table 2, below:

TABLE 1 GENDER AGE POOR FAIR AVERAGE GOOD EXCELLENT MEN ≤29 ≤37.9  38-41.6 41.7-45.5 45.6-50.9 ≥51 30-39 ≤36.6 36.7-40.6 40.7-43.9  44-47.9 ≥48 40-49 ≤34.7 34.8-38.3 38.4-42.3 42.4-45.9 ≥46 50-59 ≤31.9  32-35.4 35.5-38.9  39-42.9 ≥43 60-69 ≤28.6 28.7-32.2 32.3-35.5 35.6-38.9 ≥39 70-79 ≤25.6 25.7-29.3 29.4-32.3 32.4-35.9 ≥36 WOMEN ≤29 ≤32.1 32.3-36.0 36.1-39.4 39.5-42.9 ≥43 30-39 ≤30.8 30.9-34.1 34.2-37.6 37.7-42.9 ≥42 40-49 ≤29.3 29.4-32.7 32.8-35.9 35.9-38.9 ≥39 50-59 ≤26.7 26.8-29.8 29.9-32.5 32.6-35.9 ≥36 60-69 ≤24.5 24.6-27.4 27.3-29.6 29.7-31.9 ≥32 70-79 ≤23.4 23.5-25.8 25.9-28.0 28.1-29.9 ≥30

TABLE 2 AGE (years) POOR FAIR AVERAGE GOOD EXCELLENT ≤29   +5 +3 Actual Age −3 −5 30-39 +10 +5 Actual Age −5 −10 40-49 +5 Actual age −3 −5 −10 50-59 +5 −3 −5 −10 −20 60-69 +3 −5 −10 −20 −30 70+ +3 −5 −15 −20 −30

-   Chronological age: 29 years -   If Excellent; chronological age−5=RevUp Age -   If Good; chronological age−3=RevUp Age -   If Average; chronological age−0=RevUp Age -   If Fair; chronological age+3=RevUp Age -   If Poor; chronological age+5=RevUp Age -   Chronological age: 30-39 years -   If Excellent; chronological age−10=RevUp Age -   If Good; chronological age−5=RevUp Age -   If Average; chronological age−0=RevUp Age -   If Fair; chronological age+5=RevUp Age -   If Poor; chronological age+10=RevUp Age -   Chronological age: 40-49 years -   If Excellent; chronological age−10=RevUp Age -   If Good; chronological age−5=RevUp Age -   If Average; chronological age−3=RevUp Age -   If Fair; chronological age−0=RevUp Age -   If Poor; chronological age+5=RevUp Age -   Chronological age: 50-59 years -   If Excellent; chronological age−20=RevUp Age -   If Good; chronological age−10=RevUp Age -   If Average; chronological age−5=RevUp Age -   If Fair; chronological age−3=RevUp Age -   If Poor; chronological age+5=RevUp Age -   Chronological age: 60-69 years -   If Excellent; chronological age−30=RevUp Age -   If Good; chronological age−20=RevUp Age -   If Average; chronological age−10=RevUp Age -   If Fair; chronological age−5=RevUp Age -   If Poor; chronological age+3=RevUp Age -   Chronological age: 70+ years -   If Excellent; chronological age−30=RevUp Age -   If Good; chronological age−20=RevUp Age -   If Average; chronological age−15=RevUp Age -   If Fair; chronological age−5=RevUp Age -   If Poor; chronological age+3=RevUp Age

As indicated above, the measured VO2 level is matched in Table 1 with a customized range that is identified with a rating classified as Poor, Fair, Average, Good or Excellent. Next, their chronological age is used to determine the number to add or subtract from their chronological age based on their rated VO2, as indicated in Table 2. For example, a 60 year old male patient has a VO2max of 53. Using the <29 yrs as a baseline, this individual would fall in the excellent category and receive a 20 year reduction in his chronological age. His RevUp age would be 30 years. In another embodiment, the RevUp age may be calculated as a factor of the user's heart rate recovery, which is also another indicator that highly correlates with the user's overall health.

Creating a User Profile

After all grading systems are applied and goals set according to general parameters listed above and key genetic determinants such as susceptibility to key chronic diseases enable more stringent grading and setting of higher goals. Such information has proven highly motivational. Genetic variants for key vitamin deficiencies enable a personalized nutrition plan. Genetic data on blood pressure response to exercise and effects with respect to endurance and strength training enable personalized fitness regimens. Heart rate zones are set based on these data and overall fitness levels noted above. Patients then follow this personalized regimen and are tracked via the continuous monitoring provided by the wireless devices noted above. Constant feedback is provided via a graphical user interface of the integrated software application.

The user data is analyzed in order to generate a user profile which summarizes a multitude of health and wellness information about the user and provides metrics for assessing the user's health and wellness. The user profile may provide an overall summary or numerical value ranking of the user's health in addition to specific rankings and evaluations of specific physiological or biochemical measurements.

FIG. 9 illustrates one embodiment of a dashboard graphical user interface (GUI) 900 which lists a plurality of physiological data, including blood pressure 902, weight 904, total cholesterol 906, inflammation 908, body fat percentage 910, and sleep quality 912. Some of this information is displayed in graphical form to show historical data over a period of time, helping the user determine if they are moving in a certain direction. For example, the user in FIG. 9 is making progress in losing weight as evidenced by the chart 904, while the blood pressure chart 902 indicates that blood pressure is increasing. Some information may be displayed using color-coded graphical information, such as a yellow-colored bar for the total cholesterol level of 220 that is considered potentially unhealthy. In contrast, the indicator for inflammation is a green bar, as the measured level (1 mg/L) is within healthy levels.

FIG. 10 is an illustration of a GUI of an overall health and wellness dashboard 1000 which provides a summary of information from several different categories, including physiological data 1002, fitness data 1004, nutrition data 1006 and genetic information 1008. Specifically, FIG. 9 provides a chart with a Nutrition Overview 1006 indicating a breakdown of the levels of fat, sugar, carbohydrates and protein in the food consumed by the user over a period of time. A genetic report table 1008 may also list one or more suggestions for the user based on information obtained from the user's genetic profile, including nutrition advice, fitness advice and warnings about susceptibility to weight gain or certain diseases such as diabetes.

In one embodiment, the user profile includes general health statistics, such as age, height and weight, along with specific measurement values, such as a resting metabolic rate (RMR) at ml/kg/min at kcal/day, fitness levels (VO2 at ml/kg/min), caloric intake, body composition, visceral fat, and even physical body profile information such as alignment of joints, muscles and movement capabilities.

In one embodiment, the user profile may be displayed as a graphical user interface (GUI) 1102 to the user on a client dashboard interface such as a computer 1104 with a display or a tablet, smartphone or other portable electronic device, as shown in FIG. 11 . The client dashboard interface preferably has one or more input devices such as a mouse, keyboard or touchscreen with which the user can interact with the GUI. The GUI may be organized as a “dashboard” that provides the user with helpful summaries of a plurality of different information relating to their genetics, health, fitness, environment and nutrition in the form of visual aids on the dashboard. The information may be presented with an easily-understandable chart, graph or relevant numerical value that will help the user quickly glance at the dashboard and determine an overall sense of their current level of health and wellness, their progress toward established health and wellness goals and other pertinent information. Genomic and nutrigenomic data gathered from genomic profiles of the user may also be incorporated, such as a recommended diet type, predisposition for high blood pressure or high cholesterol, recommendations for types of exercise, and nutritional optimization (for example, if the body responds well to certain vitamins and nutritional components). In addition, health predictor tests that indicate predispositions to diabetes, cancer, etc. may also be used and incorporated into the dashboard and recommendations provided therein. A drug response test that tests a user's response (or lack thereof) to prescription drugs may also be incorporated.

Further details with regard to the dashboard GUI and its related features and functions will be provided in Section VI and the related figures, below.

V. Developing Health and Wellness Programs

In one embodiment, customized health and wellness recommendations are developed based on medical and health-related information on the interrelationships of this data. The ratings and rankings of user data determined from the above analysis will inform one or more target factors of the user's health which may fall below standard or recommended levels. Additionally, data on the user's genetic information may provide information which leads to a specific recommendation. For example, a user may be identified to have a particular genetic trait related to satiety which is known to cause a person to need to feel like they have a full stomach. If this trait is identified in the user, the health and wellness program will recommend that the user eat certain foods at certain times during the day in order to continually feel full without eating high caloric or high fat foods.

Fitness-Based Interventions

In one embodiment, the health and wellness programs may provide recommendations for fitness-based interventions such as cardio exercise which will increase the user's RMR, exercises which will achieve a certain heart rate, and diets which will reduce certain levels of fat or cholesterol that were identified as problematic in the user profile. A customized cardio interval exercise program may be used which provides for achieving varying levels of heart rate at varying time intervals over a period of time. The interval training program is designed to maximize the increase in RMR and the loss of visceral fat. The user is asked to perform a cardio-based exercise (walking or running) over specified time intervals while monitoring their heart rate in order to achieve certain heart rates at certain time intervals.

Interval training can yield numerous health benefits such as improvements in VO2max and decreasing body fat percentage including visceral fat. VO2max is an important indicator of cardiorespiratory fitness. Interval training consists of vigorous intensity periods of exercise. Greater improvements in VO2max have resulted from vigorous intensity exercise than moderate intensity exercise. Several studies have examined various volumes of interval training for health benefits. It has been shown that shorter duration, higher intensity interval programs have been effective in improving VO2max and decreasing body fat including visceral fat weight.

In one embodiment, several target heart rates to achieve at various times during the exercise are developed based on a Maximum Heart Rate (in BPM, or beats per minute) calculated for each user based on their fitness assessment. In one embodiment, the target heart rates are set as follows: Max Effort=Max Heart Rate−15 BPM Hard Work=(Max Heart Rate−20)−10 Warm up/Recovery=(Max Heart Rate−40)−10

For example, with a Max Heart Rate=200, the target heart rates during exercise would be: Max Effort=200−185 Hard Work=180−170 Warm up/Recovery 160−150

Next, the user is asked to exercise for a certain interval of time at each target heart rate and then repeat the interval as needed in order to achieve a varying level of heart rate during the exercise. One example of a Performance Improvement Interval, designed to increase the user's overall physical ability and RMR would be:

10 minute Warm-up

60-90 seconds Difficult

1 minute Max Effort

60-90 seconds Recovery

Repeat 4-6 intervals

In another embodiment, a Medical Interval may be developed for a user with an underlying medical or health issue that prevents them from achieving normal goals for exercise and health. The Medical Interval may be:

10 minute Warm-up

2 minute Difficult

1 minute Max Effort

90-120 seconds Recovery

Repeat 7 intervals

The intervals may be developed based on each user's own perceived levels of exertion, which can then be dynamically adjusted as the user completes their exercise goals. For example, one set of Intervals and Perceived Exertions would be:

Warm-up/Recovery Interval: Perceived Exertion Rate 6 (Comfortable work)

Difficult Interval: Perceived Exertion Rate 7-9 (Hard to very hard)

Max Effort Interval: Perceived Exertion Rate 10 (Maximum effort)

However, as the user continues to exercise using the cardio-based interval program, their perceived levels of exertion will decrease for each interval and corresponding heart rate. The exercise program may therefore dynamically adjust the intervals and corresponding Max Heart Rate as the user completes several exercise sessions. Over time, as their Max Heart Rate increases, their RMR will also increase, and in the process, their levels of visceral fat and other unhealthy factors will also begin to decrease.

Nutrition Based Interventions

Each user will be provided with a nutritional assessment based on their genetic, health and fitness evaluation which is designed to help the user consume foods which will maximize their health, decrease risk factors and target any genetic predispositions for certain types of foods that may particularly benefit the user. In addition, the user will be provided with a calorie goal for daily calorie consumption that includes the types of calories to consume (protein, carbohydrates, fat) and how many calories to consume at certain times of day (breakfast, lunch, dinner, morning snack, afternoon snack, pre- and post-workout snack, etc.). All of these nutritional recommendations are developed to reduce visceral body fat and are additionally customized for each user. The user will then be directed to track their food consumption in terms of the number of calories and types of calories, which will then be evaluated to ensure that the user is keeping up with their caloric and nutritional goals.

Automation of nutrition feedback will rely on the combination of a thorough health risk questionnaire, lab data, biometric data, anthropomorphic data, resting metabolic rate, genetic data, food allergies and intolerances, dietary restrictions, and food preferences.

Examples of nutritional goals and information include:

-   Daily caloric breakdown:

a. Based on daily activity level

-   -   i. Non-exercise     -   ii. Medium intensity     -   iii. High intensity

-   Daily macronutrient balance:

a. Carbohydrate: 40-50%

b. Protein: 30-40%

c. Fat: 20-30%

-   Macronutrient recommendations:

a. Complex carbohydrates

-   -   iv. Fruit, vegetables, whole grains

b. Lean Protein

-   -   v. Poultry, fish

c. Healthy fats

-   Portion control:

a. Serving sizes

-   Daily food routine:

a. Eating every 4-5 hours

-   -   vi. Blood sugar stability and boost metabolism

-   Food logging:

a. Promoting healthy behavior change

-   Supplementation:

a. If deficiencies indicated

If the user logs their food 1-2 times per week they receive an email intended to reinforce the positive behavior of food logging. The content of the email is detailed and specific to the patient, and includes tips, suggestions, and recommendations designed to keep the patient engaged in food logging.

As shown in FIG. 9 , the recommendations may indicate a genetic risk for high cholesterol and as a result indicate that further consultation with a doctor or dietician is needed in order to determine what foods will minimize the user's predisposed risk.

Medical and Genetic-Based Interventions

The recommendations may also be medical in nature, such as recommending that the user begin taking one or more medications to treat disease (such as diabetes) or reduce risks of determined genetic conditions such as high cholesterol. If a serious genetic condition is identified, the user may be provided with options for genetic therapy

The user interface in FIG. 9 and FIG. 10 may include a recommendations section which displays one or more recommendations to the user in order to help achieve one or more goals with regard to the user's health and wellness. The recommendations may be based on the user's profile and be updated based on current information that is periodically or constantly being input to the front-end cloud server by the third party data sources.

VI. The Dashboard: Monitoring and Tracking User Progress

Once the user is presented with one or more health and wellness programs and their user profile, the user may begin to implement the recommendations by making changes related to their fitness, nutrition and environment. The user may also make medical changes, such as taking a drug to reduce cholesterol or having a surgical procedure to reduce an identified risk factor. The mobile health devices may provide the means to track the user's progress toward identified goals in their health and wellness programs, by measuring the same categories of data that were initially measured when developing the user profile. In this way, the mobile health devices are integral to monitoring a user's progress and evaluating the success of the health and wellness programs. Modifications may be made on a regular basis to the health and wellness programs based on the constant stream of data that may be received from the mobile health devices and applications that the user interacts with in order to track their health.

The user profile may be displayed via an interactive dashboard graphical user interface (GUI) to users, administrators and healthcare professionals so that each interested party can not only view the data but also interact with the dashboard to provide additional recommendations to the user for improving certain aspects of their health and wellness based on the data shown in the dashboard. Changes made to the dashboard by these parties may be sent back to the front-end cloud server to immediately revise the dashboard content, and the changes may also be stored in the dashboard database for future display. The dashboard may therefore be continually revised based on the health and wellness data collected on the user and the information input by the interested parties that view the dashboard.

FIG. 3 illustrates one embodiment of a system and method of generating the interactive health and wellness dashboard, according to one embodiment of the invention. In this embodiment, data on a user is collected from a plurality of sources, such as a mobile health device, a mobile application on a portable electronic device or through manual user entry via a computing device. The mobile health devices and mobile applications may be configured to collect information on the user as the user wears or uses the device. In one embodiment, these devices may communicate with one or more device or application servers that receive data collected and then communicate with a dashboard database of a front-end cloud server to collect the data for generating the dashboard. In addition to the devices, additional user data may be collected at the dashboard database in the form of genomic data from a genomic report or lab results from lab tests that the user has undergone. The dashboard database will collect all of the medical, genetic, fitness, environmental and nutrition information about the user that will then be used to generate the dashboard. These devices may be configured to continually collect and report data to the dashboard database in real-time or at periodic increments so the dashboard can be continually updated to provide the most relevant information about the user's health and wellness. Some devices may require user input, such as a nutrition application running on a portable electronic device in which the user inputs dietary and nutrition information, and the user may be responsible for submitting the data manually as it is entered or at periodic time periods after a certain amount of data is collected. In some embodiments, the nutrition data may be obtained from mobile health devices or at least more accurately tracked by software or applications running on the portable electronic device (such as a tablet or smartphone). Similarly, some user fitness data may be generated or reported by a user.

Once the user data is collected at the dashboard database, the front-end cloud server will request the data in order to generate the health and wellness dashboard. In this embodiment, the data in the dashboard database is protected by a secure firewall, and additional firewalls may be placed throughout the system to protect data being transmitted across the system. The front-end cloud server then analyzes the data using proprietary algorithms to compare data, analyze it for patterns and then generate the health and wellness dashboard with user-specific health and wellness information based on all of the available data. The health and wellness dashboard may reflect a user profile that is generated at the front-end cloud server based on analytics which may contain recommended physiological levels for weight, heart rate, etc., recommended fitness and nutrition routines, and other recommendations based on the data collected about the user.

Once the dashboard is generated, it may be transmitted to one or more destinations for display to an interested party, including the user (patient), a healthcare team responsible for the user's health, or a corporate wellness administrator set up to monitor the user's progress toward specific health goals. The dashboard may be interactively displayed to each of these destinations so that each interested party can not only view the data but also interact with the dashboard to provide additional recommendations to the user for improving certain aspects of their health and wellness based on the data shown in the dashboard. Changes made to the dashboard by these parties may be sent back to the front-end cloud server to immediately revise the dashboard content, and the changes may also be stored in the dashboard database for future display. The dashboard may therefore be continually revised based on the health and wellness data collected on the user and the information input by the interested parties that view the dashboard.

Dashboard Organization and Interaction

Once the data is correlated and analyzed, a graphical user interface (GUI) may be generated and displayed to the user on a client dashboard interface such as a computer with a display or a tablet, smartphone or other portable electronic device, as illustrated in FIG. 12 . The client dashboard interface preferably has one or more input devices such as a mouse, keyboard or touchscreen with which the user can interact with the GUI. The GUI may be organized as illustrated in FIG. 9 , as a “dashboard” that provides the user with helpful summaries of a plurality of different information relating to their genetics, health, fitness, environment and nutrition in the form of visual aids on the dashboard. The information may be presented with an easily-understandable chart, graph or relevant numerical value that will help the user quickly glance at the dashboard and determine an overall sense of their current level of health and wellness, their progress toward established health and wellness goals and other pertinent information. Genomic and nutrigenomic data gathered from genomic profiles of the user may also be incorporated, such as a recommended diet type, predisposition for high blood pressure or high cholesterol, recommendations for types of exercise, and nutritional optimization (for example, if the body responds well to certain vitamins and nutritional components). In addition, health predictor tests that indicate predispositions to diabetes, cancer, etc. may also be used and incorporated into the dashboard and recommendations provided therein. A drug response test that tests a user's response (or lack thereof) to prescription drugs may also be incorporated.

One embodiment of the dashboard 1200 is illustrated in FIG. 12 , which displays graphics indicating the user's steps 1202, cardio goal 1204, caloric intake 1206, weight 1208 as well as additional information on this data, such as a history of caloric intake 1202 for a preceding week, a change in weight 1208 over a period of time, or a graphic indicating the percentage of steps 1202 achieved toward a goal. An activity section 1210 displays all recent activity relating to the program, such as accomplishments, data entered, points and rewards, goals, alerts, requirements, suggestions, etc. Additional graphics on the lower right will provide an overall progress graphic 1212 toward an overall program goal, such as increased RMR, fitness, metabolism, weight, etc. The user may be able to select any one of these graphics to see a more detailed breakdown of a specific data point, such as weight, for example.

FIG. 13 illustrates a health page 1300 of the dashboard interface which provides detailed graphics and indicators for numerous health metrics which are measured and tracked by the system. The health page dashboard provides the user with a unique perspective on their overall health, as measured by at least fourteen different biometric measurements 1304, such as LDL cholesterol, HDL cholesterol, triglycerides, inflammation, glucose, diabetes risk, vitamin D, thyroid (TSH), kidney, liver (AST and ALT), hemoglobin, adiponectin and hematocrit. Graphs 1302 may show historical and current data on metrics such as weight, body fat and blood pressure so the user can see trends for these indicators individually as well as together with other metrics for comparison with each other. In one embodiment, the metrics displayed may be changed by selecting different metrics from a list below the graphs. In addition to the graphs, numerous additional metrics may be listed on the health page along with the numerical value 1306 for each metric, a slider bar graphic 1308 indicating where the numerical value falls within a range of normal or expected values for the metric, and a status icon 1310 indicating whether the numerical value is good or bad (in this illustration, a “thumbs up” indicates the value is good while the thumbs down indicates the value is bad). Additionally, a bar graph 1312 underneath the title for each metric will show historical data of that metric over previous measurements, with each circle 1314 pertaining to a measurement and the color of the circle reflecting whether the measurement was a good value (i.e. blue circle) or bad value (i.e. red circle). An additional list of health-related genetics 1316 may also be provided on the health page along with an indicator 1318 as to whether the user has an elevated, decreased, normal or other level of risk for a particular genetic trait, be it a propensity for disease or simply a behavioral component related to the user's health, nutrition or fitness.

FIG. 14 illustrates a fitness page 1400 of the dashboard interface which provides detailed graphical information on the user's fitness activity, such as steps, progress toward goals of activity and cardio exercise goals 1402, current interval levels 1404 for cardiac exercise and fitness-related genetic information 1406 that reminds the user of more specific goals that may have been developed based on the user's specific genetic profile. A primary goal of the fitness page is to help the user achieve a desired heart rate range for certain levels of activity, which will lead to improved RMR, VO2, metabolism and overall cardiac health. The user is also provided with suggestions 1408 for the types of activities that can be performed to meet fitness goals, such as spinning, rowing, treadmill, etc. The user can select certain activities as favorites and also review reports on their past activities. In one embodiment, the user can create a personal fitness goal, such as “running a marathon,” after which the system will provide the user with a particular set of steps and goals to achieve in order to train for the marathon. The goals and steps may include desired RMR and VO2 levels, heart rate performance and recovery, nutrition and caloric recommendations along with balances of food types, etc.

FIG. 15 illustrates a nutrition interface 1500 of the dashboard, which provides detailed information on the user's nutrition profile and data, such as caloric intake 1502, breakdown of food type 1504 (protein, fat, carbohydrate), nutrition-related genetic information 1506 and recommendations 1508 for food intake based on the user's profile and history. The nutrition dashboard may also provide a meal plan section 1510 which provides recommendations for different types of foods which meet the user's nutrition goals in terms of calories and food type. The user may be able to select certain foods as favorites and search for foods based on the food breakdown and calorie count. In one embodiment, the user can select a certain type of food if they end up consuming it and provide a review of the food or highlight it as a favorite for the future. The system may monitor user selections and develop a suggested food plan for the user and other users based on popular selections. The system may also provide recipes for the foods on the nutrition dashboard to help the user make the selected food.

The data collected can be displayed in a wholly interactive, customizable manner depending on each particular user and depending on the viewer who will be viewing the dashboard. In the embodiments illustrated in FIGS. 9-24 , these reports may be customized for a user, a physician or healthcare team and even an administrator at a school or company who is managing a health incentives program. For example, a user with medical data indicating risk factors for chronic disease such as hypertension, hypercholesterolemia, coronary artery disease, cancer, diabetes, etc. may be categorized with specific goals to improve their mortality rates—such as nutrition and fitness recommendations, or in some cases, a recommendation to consult with a doctor to determine whether a certain disease is present.

The dashboard may also include a recommendations section which displays one or more recommendations to the user in order to help achieve one or more goals with regard to the user's health and wellness. The recommendations may be based on the user's profile and be updated based on current information that is periodically or constantly being input to the front-end cloud server by the third party data sources.

The dashboard may also include communication links where a user can communicate with a healthcare professional, nutritionist, fitness trainer, health coordinator, etc. to discuss the information on their dashboard and the recommendations being provided. The communication links may be links to separate user interfaces where the user inputs information and questions, a messaging tool where the user can send an e-mail, text message or other type of electronic message, or even a link to an audio or video application where the user can communicate with another party by voice, video or both.

The dashboard may also have a general notifications section where the user can be provided with one or more notices regarding their profile, needed actions or messages from an administrator, etc. In one embodiment, the user may be asked to visit a clinic to complete a genetic profile test or upload new data from one or more wireless health devices so that the user's dashboard may be updated.

In one embodiment, the dashboard may provide one or more information tabs where different classes of information may be grouped together in a more detailed dashboard for a particular category of information. In one embodiment, the tabs may correspond to health, nutrition, genetics and fitness. By selecting one of these tabs, a new dashboard is displayed with information specific to one of these categories, allowing the user to see a more detailed breakdown of information in this category that might not otherwise be displayed on an overall dashboard overview. The information tabs may also pertain to messaging, notifications, incentives and rewards, syncing with wireless health devices, etc.

The type of data collected and displayed on the dashboard may relate to any component of a user's genetic profile, medical information or history, fitness and nutrition. Examples of this data include heart rate, blood pressure, cholesterol, obesity, resting metabolic rate (RMR), oxygen consumption (VO2), weight, body fat, visceral fat, muscle mass, body water, bone mass, blood glucose, sleep data, caloric intake, fat intake, vitamin intake, calories burned, fat burned, steps taken (pedometer).

FIG. 9 illustrates one embodiment of a health and wellness graphical user interface (GUI) dashboard which lists a plurality of physiological data, including blood pressure, weight, total cholesterol, inflammation, body fat percentage, and sleep quality. Some of this information is displayed in graphical form to show historical data over a period of time, helping the user determine if they are moving in a certain direction. For example, the user in FIG. 9 is making progress in losing weight, while the blood pressure chart indicates that blood pressure is increasing. Some information may be displayed using color-coded graphical information, such as a yellow-colored bar for the total cholesterol level of 220 that is considered potentially unhealthy. In contrast, the indicator for inflammation is a green bar, as the measured level (1 mg/L) is within healthy levels.

The dashboard may also display one or more notifications to the user about the measured levels. In the dashboard in FIG. 9 , this user is given warning notifications about their high cholesterol levels, high blood pressure and obesity. These notifications may be based on currently measured levels of these indicators or on genetic profile information that indicates a predisposition to one or more of these conditions. The dashboard in FIG. 9 also displays a notification that the user's dashboard is incomplete since it is missing one or more items related to the user's genetic profile, medical history, fitness or nutrition. The user may be provided with a hyperlink on the notification where steps can be taken to complete the missing items, such as scheduling an appointment with a clinic to finalize a genetic test or syncing data from a wireless health device with a computer in order to update the information on the dashboard.

The dashboard may display a global summary of the user's health and wellness as a summary or home screen, but may also provide more specific dashboard GUIs specific to one type of information, such as nutrition, genetics (DNA), fitness and challenges. The challenges dashboard GUI may provide one or more activities in which the user can participate.

FIG. 10 is an illustration of a GUI of an overall health and wellness dashboard which provides a summary of information from several different categories, including physiological data, fitness data, nutrition data and genetic information. Specifically, FIG. 9 provides a chart with a Nutrition Overview indicating a breakdown of the levels of fat, sugar, carbohydrates and protein in the food consumed by the user over a period of time. A genetic report table may also list one or more suggestions for the user based on information obtained from the user's genetic profile, including nutrition advice, fitness advice and warnings about susceptibility to weight gain or certain diseases such as diabetes.

Health Alerts

The user may also receive one or more health alerts either through the dashboard 1600, as illustrated in FIG. 16 , or via a separate messaging protocol 1700 (SMS/MMS text messages, e-mails, etc.) on the user's portable electronic device, as illustrated in FIG. 17 . The alerts 1602 may tell the user that they haven't met one or more goals related to a level of fitness or nutrition or a physiological measurement related to cholesterol, body composition or blood pressure, etc. The health alerts may be tiered based on the importance of the alert or the history of response from the user. In one embodiment, a tier one health alert will be a message 1702 sent from the dashboard, while a tier two health alert is a call from a health coach, physician or other healthcare team member. A tier three health alert may be an appointment (in person or virtually) with a physician or other healthcare team member to discuss specifics of the user's health.

As illustrated in FIG. 17 , the alerts and notifications may also simply tell the user that they have received a message or notification from their system and provide them with a link to their dashboard in order to prevent transmitting any private medical or health information about the user.

In one embodiment, the health alert may be customized for a particular user based on the genetic, medical, fitness and nutrition information obtained for that user. For example, a tier one alert may be generated if the user does not have a certain minimum heart rate for a certain period of time (which would be indicative of exercise). In another embodiment, the user may receive a tier one alert if they gain more than 2 pounds in a week or 5 pounds in a month. Similar alerts may be generated for levels of blood pressure, a number of steps taken, a number of calories consumed, etc.—basically any measured value relating to health, fitness and nutrition. These alerts let the user and the user's healthcare professional know that their health and wellness goals are not being met.

Incentive Alerts

In one embodiment, the user may receive “incentive alerts” if certain levels of health, fitness or nutrition are achieved based on goals that are customized for each user. For example, a reward may be provided to the user if they walk a certain amount over a given period of time, lose or maintain a certain amount of weight, reduce their blood pressure to a certain rate, etc. As with the health alerts, the incentive alerts can be set up for any measured value relating to health, fitness and nutrition. The incentives may also be customized for each user, for members of a certain group (employees of a company), or based on user-selected preferences for rewards (monetary, lifestyle, recognition, etc.). Although the incentives may be explicitly shown on the dashboard, in one embodiment, the incentives may be provided to a user separately from the dashboard, such as by offering a user lower health insurance premiums if they enroll in a program with the dashboard and meet certain goals relating thereto.

Additional features of the incentives, as well as a points and rewards system, are described further below.

Group Reports

FIG. 18 is an illustration of a GUI 1800 of a group health and wellness dashboard illustrating a plurality of information aggregated for a group of people; according to one embodiment of the invention. The group report may display overall health and wellness information 1802 for a group of people, such as employees in a company. The group dashboard in FIG. 16 may therefore display overall averages of information, such as total weight lost by the group and an average weight loss per person 1804, a total distance run 1806, the amount of incentives and rewards 1808 provided to the group of users, the average male BMI 1810 and female BMI levels 1812, and even a total amount of sick days 1814 accrued by the group along with a comparison to previous levels. A group administrator can therefore view the details and historical levels of the group, including the goals, to determine if the group is making progress and if certain incentives are effective.

Healthcare Professional Dashboard

FIG. 19 is an illustration of a GUI of a clinical dashboard 1900 for use by a medical or healthcare professional in evaluating the health and wellness of one or more users, according to one embodiment of the invention. The healthcare professional dashboard may include a list of patients 1902 for whom the healthcare professional is responsible along with an overall summary 1904 of each patient's information, including a list of “health alerts” 1906 for users which are assigned to a particular healthcare professional. The progress 1908 of each user toward particular goals and charts and graphs of data relating to fitness and nutrition information may be displayed to the healthcare professional, along with options to obtain more detailed information on a particular user and the user's profile. Other options on the healthcare professional dashboard include the ability to communicate 1910 with each user or group of users using a built-in messaging tool (described above), a section displaying all health alerts, a section displaying notifications, a section displaying user progress toward goals, etc. The healthcare professional dashboard may also provide options for adding and enrolling new users and managing user accounts.

The healthcare professional dashboard may also provide analytical tools that help a healthcare professional analyze data from one or more users and attempt to correlate data to determine if goals and recommendations should be changed or modified. The goals and recommendations may be customized for each user by the healthcare professional or provided to an overall group of users who exhibit similar profiles.

FIG. 20 is another illustration of the GUI of the healthcare professional dashboard 2000 showing fitness alerts 2002 with detailed user profile information on a user's recent exercise regimen 2004, the type of exercise completed and the number of calories that the user burned 2006.

FIG. 21 is another illustration of the GUI of the healthcare professional dashboard 2100 displaying a list of nutrition alerts 2102 with a chart 2104 of caloric intake for a particular user over several days. The healthcare professional can see whether the user has met or exceeded a specified number of calories consumed per day and then follow up or issue an alert to the user that they are not meeting a goal of minimizing calorie consumption over a period of time. If the alert is automatically sent by the dashboard to the user, the healthcare professional may also receive the alert in the fitness alerts window and then view the detailed information to see why the user is receiving the alert.

FIG. 22 is an illustration of a GUI of an interactive messaging service 2200 integrated into the health and wellness dashboard for communication between the user and the healthcare professional. In this illustration, the healthcare professional can select an option on the dashboard to send a message to the user, which opens a new messaging window 2202 where the healthcare professional can communicate with the user to discuss their progress (or lack thereof) toward one or more goals. The messaging protocol may be any known communication medium, such as text (SMS or MMS), e-mail, instant messaging, video or audio calls, etc.

FIG. 23 is another illustration of the GUI of the healthcare professional dashboard 2300 with a weight alerts window 2302 displayed for one or more users.

Grading

The patient's progress toward their health goals may be evaluated by measuring the same parameters measured during the initial assessment phase and then determining a grade, such as a letter or numerical value which indicates the patient's progress or achievement of their goals at any point during the patient's participation. In one embodiment, the user is graded on the same values described above with regard to their assessment, including their RMR level, Body Fat Percent, Visceral Fat and VO2, as indicated in Tables 1-11 immediately below:

TABLE 1 Resting Metabolic Rate - ml/kg/min Grade Goal A > 4.51 A− 4.26-4.50  5% increase B+ 4.01-4.25 10% increase B 3.50-4.0 15% increase C+ 3.25-3.49 20% increase C 3.0-3.24 25% increase C < 2.9 30% increase

TABLE 2 Body Fat Percent Percent Goal Male Goal Female C 50 − 40% 50% decrease 40% decrease C+ 39.9 − 35% 40% decrease 30% decrease B− 34.9 − 30% 35% decrease 25% decrease B29.9% − 25% 30% decrease 20% decrease B+ 24.9% − 20% 25% decrease 10% decrease A− 19.9 − 16% 20% decrease  5% decrease A15.9 − 10% 15% decrease  0% decrease

TABLE 3 Visceral Fat lb. Grade Goal >40 lbs. C 50% decrease 35-35.99 C 50% decrease 30-34.99 C+ 45% decrease 25-29.99 lb. B− 45% decrease 20-24.99 lbs. B 40% decrease 15.0-19.9 lbs. B+ 30% decrease 10.0-14.9 lbs. A− 20% decrease <9.9 A

TABLE 4 VO2 - ml/kg/min Grade Goal A > 53 A− 49.9-52.9  5% increase B+ 45.0-49.9 10% increase B 40.0-44.9 15% increase B− 35.0-39.9 20% increase C+ 31.0-34.9 25% increase C 25-30.9 30% increase C < 24.9 35% increase

TABLE 5 Caloric Guidelines - (REE = Resting Energy Expenditure) Weight Loss range Top caloric intake = REE Peak exercise days Average caloric intake = REE − 15% Medium intensity exercise day Minimum caloric intake = REE − 20% Non-exercise day

TABLE 6 Maintenance intake range Top caloric intake = REE × 20%, Peak intensity days Average caloric intake = REE × 10%, Medium intensity days Minimum caloric intake Grading System.docxREE

TABLE 7 Bone Mass A = above average bone mass B = average bone mass C = below average bone mass

TABLE 8 Male - Average Weight Less than 143 lb., 5.9 lb Weight 143-200, 7.3 lb. Weight 200-up, 8.1 lb.

TABLE 9 Female Average Weight Less than 110, 4.3 lb. Weight 110-165, 5.3 lb. Weight 165-up, 6.5 lb.

TABLE 10 Posture/Core A = All 5 kinetic chain check points satisfactory B = 4 satisfactory kinetic check points C = 3 or fewer satisfactory check points

TABLE 11 Definition of grades C = Health Alert, high importance to improve B = Satisfactory but health potential not achieved A = Full Health Potential has been achieved

Each individual parameter may have customized levels based on the significance of each parameter to the user's overall health, and the grades for each parameter may be used individually, to provide the user with a more detailed assessment of their health, or together (such as by averaging the grades for all parameters) in order to provide the user with an overall assessment of their health. As indicated in Table 11, the grades (letter or numeric) may have specific meaning with regard to action items that the user needs to complete. The goals may be set based on levels of each parameter which are generally considered in a healthy range for all humans, or which are customized for the particular user based on their initial assessment and continuously-updated assessments.

Points and Rewards

In one embodiment, a points system may be implemented where users earn points for various activities and levels of participation, achievement of intermediate and overall goals of the program, and other activities that would benefit from incentivizing. The points may be used to compete against other users in a game to provide motivation via competition, or to earn rewards that will further motivate them to continue participation. The points system is designed to accomplish two goals: motivating participants to engage in healthy activities and providing a reliable metric for users, health care provider and organizations administering and subscribing to the system to track user participation.

The points system may be integrated into the overall dashboard and user interface 2400 so the user sees the points they earn for each activity and goal, as shown in FIG. 24 . The Recent Activity feed section 2402 displays the points 2404 associated with all the health-related activity of the participant so they can see the reward from their activities in real-time. Points may be weighted so that actions with higher impact on health and/or greater levels of participation receive more points. Participants can then see which activities 2406 provide more points, thus motivating them to engage in those healthy behaviors more frequently.

Users can earn points every time they track their activity, exercise, food intake, blood pressure and other metrics. Additional points may be awarded with a participant achieves a health goal or milestone. The system allows providers to decide what levels of participation they would like to set for their users to receive rewards and incentives, which may be tied to the overall goal of the provider or organization.

FIG. 25 illustrates a table with one embodiment of a points system which rewards points to users based on recording activity with an activity tracking device (such as a Fitbit), taking a certain amount of steps per day, an amount of heavy activity per day, recording the user's weight with a scale, logging food and achieving specific overall step goals. Different Groups A, B and C may be created based on different levels of participation within the system, such that some groups may not participate in certain activities and tracking. A threshold value may be provided within each activity that defines a minimum amount of the activity that will earn the points. For example, in order to earn points for logging food each day, the user must log at least 500 calories worth of food. An additional threshold value may be provided, as indicated in the far right column, which provides the maximum value of points that can be earned for a particular activity over the course of the program. Providing intermediate awards and points will help motivate users along the way and help users who may not achieve a reward in one month to work toward a reward in a subsequent month.

FIG. 26 illustrates an outcome-based points system which awards points based on achieving certain outcomes or progress toward an outcome, such as a desired RMR, visceral fat, body fat, VO2 or HbA1c. In this embodiment, the points are awarded as a percentage of the user's achievement of the outcome, such that a user who attains 90% of their set RMR goal will obtain 90% of a total of 250 possible points. These points may be awarded at various assessments during the program as well as at the end of the program.

FIG. 27 illustrates possible incentives and rewards that may be provided to the various Groups by each program sponsor or provider. The incentive design refers to whether the incentive is designated for a specific individual user or a group of users based on group achievement. For example, in FIG. C, the Group C (Example 3) may be provided with a group-designed incentive based on an arrangement of 14 groups of 5 people who are all blindly participating in the groups. An incentive, such as cash, may be awarded to the individuals that hit their thresholds within each group, where the cash award is divided by the winners on a monthly basis. Other incentives include fitness devices, exercise equipment or activity tracking devices to further motivate the user to participate in the program. As illustrated in the right column, another option is to provide awards to top improvers and point gainers in order to motivate users who may have more difficulty achieving the goals.

FIG. 28 illustrates several additional activities that may be incentivized through points and rewards. For example, activities that could earn points include logging blood pressure, attaining a threshold value of very active minutes, recording interval training sessions with a heart rate monitor, taking a blood glucose reading (i.e. for a diabetic), consecutive days of food logging or logging 90 minutes of exercise over a 3 day period. The point values and thresholds for each of these activities may be customized as needed in order to provide the right amount of incentivizing to certain groups of users.

VII. Outcomes

Over ninety percent of patients participating in the embodied methods experienced statistically significant improvements in resting metabolism, body fat, visceral fat reduction and improvements in cardiorespiratory fitness.

FIG. 29 is a table illustrating measured physiological changes in a set of patients using the systems and methods described herein over a period of time. The table illustrates changes the various physiological parameters on a per-day value, and also rates the statistical significance of the results (p-value) for the overall change in a parameter. A p value of less than 0.05 generally means that there is a statistically significant improvement in that individual parameter. The table also indicates the statistical significance of age and sex on the changes observed for each value amongst the group of patients. As shown in the table, almost all measured parameters changed over the course of the program. Age was not a factor in influencing a patient's response to the program, although sex (gender) had some influence on patient response to some of the parameters. The measurements of VO2, RMR and decreases in visceral fat are tightly linked to reduced death, and are considered key performance metrics.

FIGS. 30-35 are graphical representations of the measured physiological changes in a group of patients over a period of days. FIG. 30 illustrates the overall statistical change in numerous health metrics, including BMI, body fat, trunk fat, RMR and VO2. FIG. 31 illustrates the change in BMI, FIG. 32 illustrates the change in body fat, FIG. 33 illustrates the change in trunk fat, FIG. 34 illustrates the change in resting metabolic rate (RMR) and FIG. 35 illustrates the change in VO2.

VIII. Scalable Personalized Care

While many of the above embodiments were described in the context of developing a personalized health and wellness program for an individual based on their personal profile, one of skill in the art will recognize that the systems and methods described apply to populations as well. As noted above grading and/or other metrics can be used to assess a user's health. User profiles can then be associated with summaries of, e.g., numerical values associated with the grades or metrics. These summary user profiles can then be associated with health and wellness programs.

In other words, as more and more individuals use the system, the system can generate more and more summary user profiles based on the grades and metrics. Associated with these summary profiles are health and wellness programs designed and shown to improve outcomes associated with the conditions associated with the summary user profiles. These health and wellness programs can comprise activities to engage in or avoid, nutrition advice, medications, etc., as well as interventions shown to improve adherence based on feedback received related to the individual's engagement, adherence and progress.

The interventions are messages or other information that can be sent to the individuals in order to help them with engagement and adherence. Initially, a set of interventions can be associated with a profile, but as feedback is received the interventions can change. For example, as illustrated in FIG. 38 , the feedback can indicate the level of an individual's motivation to change as well as their ability to change. The ability to change can be indicated by their awareness of and ability to understand information related to their health. Metrics can then be used to measure these variables and a plot can be developed as illustrated in FIG. 38 . The types of interventions used, or the purpose of those interventions can then be changed based on where the user falls on the plot or graph. Use of the systems and methods described herein have demonstrated that if a user is highly motivated and have the ability to change, then they just need to be encouraged. If they have the ability to change, but are not very motivated, then they need to be motivated. If they do not have the ability and are not very motivated, then the interventions must serve the purpose of educating the user. Finally, in this example, if the user is motivated, but not really aware, then the purpose of the interventions must be to teach them about their health, etc.

Thus, as feedback is received, the interventions that go along with the plan specified by the user profile can change to suit the type of individual. In this way the whole plan becomes more personalized to the individual, but in a scalable fashion. It will also be understood that the plot illustrated in FIG. 38 can be segmented into more or fewer groups and can be based on more or fewer factors or characteristics.

The feedback noted above can lead to modifications in the plan, but it can also lead to a re-assigning of user profile. For example, a different profile, and therefore plan and interventions, may be associated with a subject that has hypertension and a BMI over a certain threshold, versus a subject that has hypertension but a BMI below the threshold. A particular subject may start out with hypertension and a BMI over the threshold. But over time, if the user adheres to their plan, their BMI may go down thus causing them to be “re-assigned” to the profile and therefore plan and interventions associated with hypertension and the lower BMI.

The above is a simple example, but it can easily be seen how the platform described herein can be used to generate a virtually limitless number of profiles and therefore plans and sets of interventions based on a virtually limitless number of factors or conditions. Of course the plans and interventions are designed to achieve certain outcomes.

In fact large populations can have 450+ chronic diseases and comorbidities. But the platform described above can apply hundreds of algorithms to sort the population by, e.g.: Care plan; clinical data; lifestyle and habits; and behavioral traits. Tiered interventions based on real-time analytics for groups of patients can then be applied to help adherence to the associated plans. The result is a high touch care model for large populations resulting in greater patient engagement and outcomes. This is critical because conventional approaches are not succeeding in reducing the burden of chronic diseases in the population.

The United States Government spends nearly $800 billion annually on patients with chronic conditions. This represents greater than 80% of all government dollars spent on healthcare. Despite this cash outlay, the United States remains dead last of OECD countries on almost all healthcare quality measures. The figures are even more staggering in our elderly population with Medicare spending over 90% of their $620 billion on managing chronic disease.

With the prevalence of chronic conditions rapidly rising, and the number of seniors growing to over 80 million by 2030, the United States government faces the challenge of keeping its programs economically viable. At current rates, Medicare spending would rise to nearly $1 trillion in the next decade. Recognizing this, the Senate Finance Committee established a bipartisan chronic care working group to develop and implement policies designed to improve disease management, streamline care coordination, improve quality and reduce Medicare costs. Part of the debate centered on the evaluation and potential expansion of a new chronic care management initiative introduced in 2015 by Centers for Medicare and Medicaid Services (CMS).

With a long history of catalyzing innovation in healthcare, the Centers for Medicare and Medicaid Services (CMS) instituted a new fee-for-service reimbursement code aimed at incentivizing providers to deliver population health management services to Medicare patients with two or more chronic conditions. The goal of this initiative is to promote high-touch patient care between office visits. Specifically, starting on Jan. 1, 2015, physicians can be reimbursed an average of $43 for each eligible patient per month for twenty minutes of care management services. These services must include creating a comprehensive care plan, reconciling medication, and messaging patients regarding their medical, functional and psychosocial needs. Currently, more than 35 million Medicare patients qualify for this new Chronic Care Management code (CPT 99490) and this number is projected to grow to more than 60 million by 2030. This new reimbursement code has created a $15 billion revenue opportunity for providers of CCM services.

Despite the financial incentives, only 100,000 bills for CCM services were submitted at the end of October 2015, according to CMS sources. The low adoption is a consequence of compliance concerns by providers, high burden of required documentation, and lack of readily available care management personnel and scalable technology. For example, data from surveys suggest that the majority of providers participating in CCM spent more than 35 minutes delivering CCM services to each patient instead of the required 20 minutes. These facts demonstrate the challenges faced by providers who attempt to implement CCM services within existing provider workflows using one-to-one, mostly telephonic, interactions. Nevertheless, the evidence that such programs could improve patient outcomes and reduce costs is overwhelming.

Given these challenges, the only way to cost-effectively manage large populations with chronic disease is through a platform such as that described above. As noted above such a platform can collect and integrate patient data from multiple sources. This allows a care manager to scale their efforts to address a large population. As a result, care managers including nurses, dieticians, etc., can deliver effective, high-touch, personalized care to a large patient population. Further, data collected by systems and methods described herein can be used to generate valuable insights that inform approaches to managing chronic diseases in future patients.

In one large study using the platform described herein a multidisciplinary clinical care team was led by a registered nurse and included nutritionists, exercise specialists, IT support specialists and data scientists provided the chronic care management services. The team delivered high-touch personalized care using the digital platform described above, which enabled secure asynchronous messaging between a patient and the care team. The platform also collected and aggregated patients' clinical, behavioral and lifestyle data through interoperability with electronic health record systems (EHRs), integration with digital devices and self-reporting by patients using the platform's web or mobile interface. Collected data included clinical metrics such as weight, blood pressure and blood glucose measurements, the frequency and intensity of physical activity, timing and composition of a patient's diet, psychosocial aspects such as self-efficacy and readiness to change and other relevant health data. Patient's care management services were initiated by assembling the patient's care plan, which contained information regarding patient's diagnoses, medications, social history, allergies, functional status and clinical goals. Additional health and psychosocial information was obtained via a health assessment survey. Collectively, this information guided the care team in managing and coordinating the patient's chronic care. Care team members continually reviewed and interpreted patient's incoming data, consulted the care plan and provided personalized feedback via secure messaging several times per week.

Personalized messages educated patients about their chronic conditions, encouraged the self-tracking of relevant data, promoted medication adherence and provided feedback regarding patients' behavior and activities. In addition, personalized health coaching promoted physical activity and healthy diet. Clinical team members also coordinated care between the patient and the provider when patients provided out-of-range clinical values. For patients without access to an internet-enabled digital device, all services were delivered by traditional mail. With this delivery method, all self-reported data were digitized and care was managed within the digital platform. Collectively, clinical team members spent an average of 20-25 minutes reaching out to a single patient each month.

The digital platform contained an analytic engine that provided a decision support system to the care team. This engine used all available patient data to continually sort the diverse patient population into groups based on their demographic, clinical and behavioral characteristics. For example, one such patient group comprised all obese diabetic patients with elevated blood glucose levels and low levels of physical activity. Clinical team member could message all patients within this group collectively, scaling the efficiency of chronic care management delivery. This decision support also enabled the prioritization of care by grouping patients according to the severity of their condition. Patient engagement and improved outcomes were constantly monitored and analyzed with the aim of identifying efficacious interventions and successful engagement strategies for specific groups of patients, which could be used in delivering more efficacious care to future patients with similar characteristics.

The process is illustrated in FIG. 37 in which it can be seen that a large population 3700 was continually sorted into specific patient groups 3702 based on demographic, clinical and behavioral data. Each group 3702 is defined by a patient or user profile that not only specifies a health and wellness program 3704 but also a tiered set of interventions to be used based on feedback received from the patients. Interventions were delivered to all patients in each group collectively using secure asynchronous digital messaging. Using the platform in this manner provided a scalable personalized chronic care management delivery model.

But it should also be noted that over time, the patients did not just move “down” into groups 3702, but that the continuous sorting caused them to also move “laterally” between groups as the feedback received indicated they should now be associated with a new group or user profile. Each patient may also be in several different groups at once.

It should also be noted that the platform described above and the process of using information about each individual to sort them into user profile groups 3702 also allows a single or few practitioners or care providers/coordinators 3706 to manage a large group of individuals 3700. This simply cannot be done without the systems and methods described herein.

The study indicated significant improvement in systolic blood pressure (SBP) measured in mm Hg, and blood glucose (BG) measured in mg/dL. Multiple measurements provided within each week were averaged. Baseline measurement was defined as the average of all patients' values provided in the week of the patient's first self-reported measurement. Similarly, the final measurement was defined as the average of all patients' values provided in the week of the patient's last measurement. Improvements in outcome measures were assessed in all patients who provided relevant data on multiple occasions during a minimum of two weeks (not necessarily consecutive), and whose baseline measurements were at or above a clinically meaningful threshold value. For systolic blood pressure this threshold value was set at 135 mm Hg, for blood glucose the threshold was set at 140 mg/dL.

The primary analysis consisted of comparing baseline and final measurements. Statistical significance of the improvements in clinical measures was determined using a paired t-test when assumptions of normality and homogeneity of variances were met. Otherwise, a non-parametric Wilcoxon signed rank test with continuity correction was applied. Correlation between improvements in clinical measures and the length of time after enrollment was assessed using Pearson r correlation coefficient. Trends of clinical measurements over time were analyzed using a linear regression model. Bonferroni correction for multiple comparisons was applied wherever necessary.

A total of 6,532 Medicare recipients with two or more chronic conditions consented to participate and were enrolled in the chronic care management program. Of these patients, 1,518 interacted with a clinical team member or self-reported data. Specifically, 277 patients provided SBP measurements and 156 provided BG data during at least two weeks. One hundred and twenty-four (124) of these patients exhibited baseline values that were consistent with uncontrolled hypertension (>135 mm Hg), and 72 patients' baseline values were at or above the clinical threshold of 140 mg/dL. These patients were included in the follow-up to assess potential reduction in clinical metrics while receiving chronic care management services.

Clinically and statistically significant reductions in SBP and BG levels were observed after an average of 6 weeks of receiving chronic care management services. Notably, when clinical outcomes among all 277 and 156 patients who provided SBP and BG measurements were examined, greater improvements in patients with greater severity of disease as defined by American Heart Association and Bergenstal et al., were observed.

Trends of SBP and BG measurements in time using linear regression (see FIG. 5 ) were also analyzed. A statistically significant decreasing trend in both SBP (slope: −0.9 mm Hg/week) and BG measurements (slope: −1 mg/dL/week) were observed. This analysis provided further evidence that patients' improvements in clinical outcomes are causally related to receiving chronic care management services enabled by a platform such as described herein.

The number of patients who achieved clinically significant reductions in clinical metrics was also determined. Thirty-six patients (29%) with baseline SBP above 135 mm Hg reported final values below that threshold (mean=121.5 mm Hg). Similarly, 24 patients (33%) with elevated BG at baseline reduced their measurements below 140 mg/dL (mean=122.3 mg/dL) in their final week of self-tracking. Patients achieved these reductions after less than two months of chronic care management services.

Existing chronic care management models, which focus on treating 5% of chronic disease patients with complications and multiple comorbidities, have failed to reduce healthcare costs. Chronic care management services must be expanded to the many millions of patients with one or more chronic diseases in order to prevent them from becoming high users of healthcare resources; however, conventional chronic care management systems are incapable of scaling up their delivery, because a single case manager can deliver care to only 100-200 patients at a cost exceeding $200 per patient per month. Thus, providing chronic care management to, e.g., all 35 million Medicare recipients with two or more chronic conditions would require five times the number of currently certified case managers, and cost $84 billion, nearly 15% of Medicare spending.

But the above demonstrates that the systems and methods described herein can be used to deliver chronic care management services to more than 6,500 Medicare recipients with chronic conditions in a time and cost effective manner. As noted, the systems and methods described herein allow the dynamic sortation of patients into groups that are associated with a user profile that also defines health and wellness programs and tiers interventions.

This allows a single care manager to provide relevant personalized chronic care to, e.g., 800 patients, reducing the cost of delivery ten-fold to just $20 per patient per month. The outcomes achieved in the study were significant considering the low cost to deliver the solution. Enrolled patients with uncontrolled hypertension or pre-diabetes exhibited clinically as well as statistically significant reductions in these clinical metrics after just 6 weeks on average.

With respect to outcomes, it should be noted that as outcomes are determined for such large populations 3700, vast amounts of data can be gathered related to what user profiles, i.e., programs and interventions, works best for certain individuals and/or groups 3702. This information can then be used to adjust the profiles including adjusting the program as well as the type of interventions used for individuals identifiable by various characteristics. These characteristics can be related to their health, their medical conditions, their psychosocial profile, etc.

It should also be noted that the adjustments to the profiles my result in new profiles, i.e., groups 3702. Thus, the systems and methods described not only allow for a small number of individuals to manage a large population, but the systems and methods also enable constant increase in the effectiveness of the care as measured by outcomes.

IX. Computer Embodiment

FIG. 36 is a block diagram that illustrates an embodiment of a computer/server system 3600 upon which the systems and methods described above can be implemented. The system 3600 includes a computer/server platform 3601 including a processor 3602 and memory 3603 which operate to execute instructions configured to carry out the processes described above. The term “computer-readable storage medium” as used herein refers to any tangible medium, such as a disk or semiconductor memory, that participates in providing instructions to processor 3602 for execution. Additionally, the computer platform 3601 receives input from a plurality of input devices 3604, such as a keyboard, mouse, touch device or verbal command. The computer platform 3601 may additionally be connected to a removable storage device 3605, such as a portable hard drive, optical media (CD or DVD), disk media or any other tangible medium from which a computer can read executable code. The computer platform may further be connected to network resources 3606 which connect to the Internet or other components of a local public or private network. The network resources 3606 may provide instructions and data to the computer platform from a remote location on a network 3607. The connections to the network resources 3606 may be via wireless protocols, such as the 802.11 standards, Bluetooth® or cellular protocols, or via physical transmission media, such as cables or fiber optics. The network resources may include storage devices for storing data and executable instructions at a location separate from the computer platform 3601. The computer interacts with a display 3608 to output data and other information to a user, as well as to request additional instructions and input from the user. The display 3608 may therefore further act as an input device 3604 for interacting with a user.

The above description of disclosed embodiments is provided to enable any person skilled in the art to make or use the systems and methods described herein. Various modifications to the embodiments will be readily apparent. Moreover, any generic principals defined herein can be applied to other embodiments not necessarily described. Thus, the invention is not intended to be limited to the embodiments shown herein but is to be accorded the widest scope consistent with the principals and novel features disclosed herein. 

The invention claimed is:
 1. A method of implementing personalized health and wellness programs, comprising the steps of: collecting and aggregating for each user in a user population clinical, behavioral, and lifestyle data via interoperability with electronic health record systems, integration with one or more health devices associated with each of the users, and via self reporting by each of the users; generating a plurality of summary health profiles based on the aggregated data, each of the plurality of summary health profiles being associated with a health and wellness program, and a set of interventions; sorting each of the users into multiple summary health profiles of the plurality of summary health profiles, based on the collected data for each user and the aggregated data for each summary health profile; and for each of the users: collecting health data pertaining to the user, the health data including a first health metric; receiving user activity data and updated health data pertaining to, or during the user's participation in the associated health and wellness program from the one or more health devices; in response to receiving of the user activity data and the updated health data, automatically selecting in real-time a new set of interventions related to the summary health profile associated with the user based on the user activity data, wherein selecting the new set of interventions comprises, in real-time: selecting a first type of communication based on the user activity data, sending the first type of communication to the user, and selecting a second type of communication based on user feedback to the first type of communication and the user activity data; based on the updated health data, determining that the first health metric has crossed a predetermined threshold; in response to the determination that the first health metric has crossed a predetermined threshold, automatically selecting a new summary health profile associated with a new health and wellness program and a new set of interventions from the plurality of summary health profiles; and updating a user interface of the user based on the new summary health profile and the new set of interventions.
 2. The method of claim 1, wherein the health data is at least one of: medical history, genetic data, nutrition data, fitness data and environmental data.
 3. The method of claim 1, wherein the health data includes clinical metrics such as blood pressure, blood glucose or weight.
 4. The method of claim 1, further comprising simultaneously transmitting notifications or messages in accordance with the associated interventions to each of the users associated with a same health profile of the plurality of health profiles regarding each of the user's participation in the health and wellness program.
 5. The method of claim 4, further comprising determining, based on the health data and the user activity data the degree to which each user is aware of their health metrics and motivated to change.
 6. The method of claim 5, wherein a new set of interventions is selected based on the degree to which a particular user is aware of their health metrics and motivated to change.
 7. The method of claim 6, wherein the notifications or messages associated with a new set of interventions are intended to do at least one of the following motivate, encourage, teach, and educate, depending on the degree to which the user is aware of their health metrics and motivated to change.
 8. The method of claim 1, further comprising determining an outcome for each of the users.
 9. A method of implementing personalized health and wellness programs, comprising the steps of: collecting health data pertaining to a plurality of users, the health data including a first health metric; sorting each of the plurality of users into groups by selecting a summary health profile from a plurality of summary health profiles with aggregated data based on the collected health data, each of the plurality of summary health profiles being associated with a health and wellness program and a set of interventions; receiving user activity data and updated health data pertaining to, or during each of the plurality of the user's participation in the associated health and wellness program from one or more health devices associated with each of the plurality of users; in response to receiving the user activity data, for at least some of the plurality of users, automatically selecting in real-time a new set of interventions based on the associated user activity data, wherein selecting the new set of interventions comprises, in real-time: selecting a first type of communication based on the associated user activity data, sending the first type of communication to the at least some of the plurality of users, and selecting a second type of communication based on user feedback to the first type of communication and the associated user activity data; and for some of the plurality of users, (i) determining that the first health metric of the updated health data has crossed a predetermined threshold, (ii) based on the determination, automatically sorting them into new groups by selecting a new summary health profile from the plurality of summary health profiles, and (iii) updating one or more user interfaces based on the new summary health profile.
 10. The method of claim 9, wherein the health data includes at least one of: medical history, genetic data, nutrition data, fitness data and environmental data.
 11. The method of claim 9, wherein the health data includes clinical metrics such as blood pressure, blood glucose or weight.
 12. The method of claim 9, further comprising transmitting notifications or messages in accordance with the associated interventions to each of the plurality of users regarding the user's participation in the health and wellness program.
 13. The method of claim 12, further comprising, for each of the plurality of users, determining based on the health data and the user activity data the degree to which the user is aware of their health metrics and motivated to change.
 14. The method of claim 13, wherein the new set of interventions is selected based on the degree to which the user is aware of their health metrics and motivated to change.
 15. The method of claim 14, wherein the notifications or messages associated with the new set of interventions are intended to do at least one of the following motivate, encourage, teach, and educate, depending on the degree to which the user is aware of their health metrics and motivated to change.
 16. The method of claim 9, further comprising determining an outcome for each of the users.
 17. A system for implementing personalized health and wellness programs, comprising: one or more storage devices configured to store user health data and user activity data; memory configured to store instructions; one or more processors coupled with the one or more storage devices and memory, wherein the instructions are configured to cause the one or more processors to: collect health data pertaining to a user, the health data including a first health metric; select multiple summary health profiles from a plurality of summary health profiles with aggregated data based on the collected health data, each of the plurality of summary health profiles being associated with a health and wellness program and a set of interventions; receive user activity data and updated health data pertaining to, or during the user's participation in the associated health and wellness program from one or more health devices; in response to receiving the user activity data, automatically select in real-time a new set of interventions based on the user activity data, wherein selecting the new set of interventions comprises, in real-time: selecting a first type of communication based on the user activity data, sending the first type of communication to the user, and selecting a second type of communication based on user feedback to the first type of communication and the user activity data; determine that the first health metric has crossed a predetermined threshold based on the updated health data; in response to the determination that the first health metric has crossed a predetermined threshold, select a new summary health profile from the plurality of summary health profiles; and in real-time, updating a user interface of the user based on the new summary health profile.
 18. The system of claim 17, wherein the health data is at least one of: medical history, genetic data, nutrition data, fitness data and environmental data.
 19. The system of claim 17, wherein the health data includes clinical metrics such as blood pressure, blood glucose or weight.
 20. The system of claim 17, wherein the instructions are further configured to cause the one or more processors to transmit notifications or messages in accordance with the associated interventions to the user regarding the user's participation in the health and wellness program.
 21. The system of claim 20, wherein the instructions are further configured to cause the one or more processors to determine, based on the health data and the user activity data the degree to which the user is aware of their health metrics and motivated to change.
 22. The system of claim 21, wherein the new set of interventions is selected based on the degree to which the user is aware of their health metrics and motivated to change.
 23. The system of claim 22, wherein the notifications or messages associated with the new set of interventions are intended to do at least one of the following motivate, encourage, teach, and educate, depending on the degree to which the user is aware of their health metrics and motivated to change.
 24. The system of claim 17, wherein the instructions are further configured to cause the one or more processors to determine an outcome for the user.
 25. A system for implementing personalized health and wellness programs, comprising: one or more storage devices configured to store user health data and user activity data; memory configured to store instructions; one or more processors coupled with the one or more storage devices and memory, wherein the instructions are configured to cause the one or more processors to: collect and aggregate for each of a plurality of users in a user population health data including clinical, behavioral, and lifestyle data via interoperability with electronic health record systems, integration with one or more health devices associated with each of the users, and via self reporting by each of the plurality of users, wherein the clinical data includes a first health metric; sort each of the plurality of users into groups by selecting a summary health profile from a plurality of summary health profiles with aggregated data based on the collected health data, each of the plurality of summary health profiles being associated with a health and wellness program and a set of interventions; receive user activity data and updated health data pertaining to, or during each of the plurality of the user's participation in the associated health and wellness program from one or more health devices associated with each of the plurality of users; in response to receiving the user activity data, for at least some of the plurality of users, automatically select in real-time a new set of interventions based on the associated user activity data, wherein selecting the new set of interventions comprises, in real-time: selecting a first type of communication based on the user activity data, sending the first type of communication to the at least some of the plurality of users, and selecting a second type of communication based on user feedback to the first type of communication and the user activity data; for some of the plurality of users, (i) determining that the first health metric has crossed a predetermined threshold, (ii) based on the determination, sorting them into new groups by selecting a new summary health profile from the plurality of summary health profiles; and (iii) update a user interface based on the new summary health profile.
 26. The system of claim 25, wherein the health data includes at least one of: medical history, genetic data, nutrition data, fitness data and environmental data.
 27. The system of claim 25, wherein the health data includes clinical metrics such as blood pressure, blood glucose or weight.
 28. The system of claim 25, wherein the instructions are further configured to cause the one or more processors to simultaneously transmit notifications or messages in accordance with the associated interventions to each of the plurality of users associated with a particular user health profile regarding the user's participation in the health and wellness program.
 29. The system of claim 28, wherein the instructions are further configured to cause the one or more processors to, for each of the plurality of users, determine based on the health data and the user activity data the degree to which the user is aware of their health metrics and motivated to change.
 30. The system of claim 29, wherein the new set of interventions is selected based on the degree to which the user is aware of their health metrics and motivated to change.
 31. The system of claim 30, wherein the notifications or messages associated with the new set of interventions are intended to do at least one of the following motivate, encourage, teach, and educate, depending on the degree to which the user is aware of their health metrics and motivated to change.
 32. The system of claim 25, wherein the instructions are further configured to cause the one or more processors to determine an outcome for each of the users. 